BECOME A DONOR

50% of Wisconsinites have shared their intent to donate. But we can do more! Join the effort to get to 75% by 2010.

Take a moment to fill out the form below, which goes directly to the Department of Motor Vehicles. You are required to fill out all the information, including a "statement" confirming your donation.

A statement such as: "I would like my record to reflect that I would like to be an organ and tissue donor."

Upon receipt of your email, the DMV will mail you an orange donor dot that you can place on your license or state I.D.

 

You are NOT required to provide your phone number.


Name : Phone :
Email : City/Town :
Address : State :
Zip Code : License Number:
Statement:
 
   

                                               
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